ATTACHMENT 3 Experience Questionnaire.pdf

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Seedlings
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12444121Q0014
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12444121Q0014

ATTACHMENT 3

EXPERIENCE QUESTIONNAIRE

1. Contractors Name, Address, Telephone No., & Email 2. DUNS Number:

3. How many years experience do you have in this line of work_____Years

4. LIST OF ANY RELATIVE PROJECTS YOUR BUSINESS HAS COMPLETED WITHIN THE LAST (3) YEARS:

NOTE: The description of work performed should be in sufficient detail for the Government to determine what the work included.

(i.e., what tasks were performed, (grounds maintenance, erosion control, mulching, forestry work performed, type of equipment used, special safety or requirements) Use of only a project title does not usually provide enough detail for the Government to make an evaluation.

Contract Number:______________________________________ Award Amount: _________________________________

Client/Company’s Name/Address: ________________________________________________________________________

Contact Name and Telephone number: ____________________________________________________________________

Description of Work Performed: _________________________________________________________________________

Date completed or scheduled for completion: ______________________________________________________________

Contract Number:______________________________________ Award Amount: _________________________________

Client/Company’s Name/Address: ________________________________________________________________________

Contact Name and Telephone number: ____________________________________________________________________

Description of Work Performed: _________________________________________________________________________

Date completed or scheduled for completion: ______________________________________________________________

Contract Number:______________________________________ Award Amount: _________________________________

Client/Company’s Name/Address: ________________________________________________________________________

12444121R0021

ATTACHMENT 2

EXPERIENCE QUESTIONNAIRE

Contact Name and Telephone number: ____________________________________________________________________

Description of Work Performed: _________________________________________________________________________

Date completed or scheduled for completion: ______________________________________________________________

6a. Have you ever failed to complete any work awarded to you? ___Yes ___ No

7. If "yes" to item 6a - specify location(s) and reason(s) why:

CERTIFICATION: I certify that all of the statements made by me are complete and correct to the best of my knowledge and that any persons named as references are authorized to furnish the Forest Service with any information needed to verify my capability to perform this project:

Name:

Title: Date:

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